Revision History
All physicians who supervise and/or interpret CT examinations must be licensed medical practitioners who meet the following minimum criteria:
Requirements for all Physicians Supervising and/or Interpreting CT Examinations | ||
Initial Qualifications | ||
Board-Certified Radiologist | Non-Board Certified Radiologist | Other Physician |
| All of these:
| All of these:
|
Continuing Experience | ||
Upon renewal, physicians reading CT examinations must demonstrate one of the following:
Additional information regarding continuing experience requirements | ||
Continuing Education | ||
Upon renewal must meet one of the following:
Additional information regarding continuing education requirements |
*Completion of an accredited radiology residency in the past 24 months will be presumed to be satisfactory for the reporting and interpreting requirements for both initial and continuing experience.
Occasional readers who are providing imaging services to and for the practice are not required to meet the interpreting physician initial qualifications or continuing experience requirements. However, the reads of all occasional readers combined should not exceed 5% of the total volume of reads per practice and per modality. There must be an active written review process in place at the institution for occasional readers based on each institution’s credentialing requirements. Validation of this process will take place during any site visit by the ACR.
Requirements for all Physicians Supervising and/or Interpreting Cardiac CT Examinations** | ||
Initial Qualifications | ||
Board-Certified Radiologist | Non-Board Certified Radiologist | Other Physician |
| All of these:
| Cardiologists - Cardiac ONLYCertification in cardiology by the American Board of Internal Medicine with completion of Level 2 training or higherLevel 2 Requirements (All of the following):
Level 3 Requirements (All of the following):
Nuclear Medicine Physicians - Cardiac ONLYAll of these:
In addition:
OR
|
Continuing Experience | ||
Additional information regarding continuing experience requirements | ||
Continuing Education | ||
Additional information regarding continuing education requirements |
**Note: Reading calcium scoring CT exams does not count toward certification to interpret CCTA exams and reading calcium scoring exams does not require the CCTA certification. However, calcium score readers should understand there are cardiac-specific anatomy, quality-control, interpretation, and recommendation considerations that make relevant cardiac education/training beneficial.
In addition, all physicians interpreting CT examinations must:
Have completed an accredited diagnostic radiology residency or 80 hours of documented, relevant classroom instruction including diagnostic radiology and radiation safety physics. Otherwise, physicians must demonstrate training in the principles of radiation protection, the hazards of radiation exposure to both patients and radiological personnel, and appropriate monitoring requirements.
Be thoroughly acquainted with the many morphologic and pathophysiologic manifestations and artifacts demonstrated on computed tomography. Additionally, supervising physicians should have appropriate knowledge of alternative imaging methods.
Be knowledgeable of patient preparation, and training in the recognition/treatment of adverse effects of contrast materials for these studies, as described in the ACR-SPR Practice Parameter for the Use of Intravascular Contrast Media.
Be responsible for reviewing all indications for the examination; specifying the use, dosage, and rate of administration of contrast agents (per the 2005 ACCF/AHA Clinical Competence Statement on Cardiac CT and MR, specifying the imaging technique, including appropriate windowing and leveling; interpreting images; generating written reports; and maintaining the quality of both the images and interpretations.
Be familiar with the meaning and importance to the practice of CT of: total radiation dose to the patient; exposure factors; conscious sedation principles that are performed in the practice; and post-processing techniques and image manipulation on work stations.
Regarding intravascular contrast media:
The following providers may be considered capable of providing direct supervision1 of intravenous contrast material administration*, subject to applicable state and federal law:
A radiologist (MD/DO)
Or – one of the following under the general supervision2 of a radiologist
Non-radiologist physicians (MD/DO)
Advanced practice provider (NP, PA)
Registered nurses following a symptom- and sign-driven treatment algorithm
*Note: supervision in this context only applies to administration of intravenous contrast media, not to the supervision of the radiologic examination or procedures.
This change would align radiology with the recognized skills of the aforementioned providers who are capable of managing acute hypersensitivity reactions to other drugs.
Responsible providers should be trained in, and periodically demonstrate competence in:
Managing acute hypersensitivity and physiologic drug reactions. This may be done using diagnostic decision-making, or by use of a symptom- and sign-driven treatment algorithm as commonly is used by nursing.
Appropriately administering reassurance, oxygen, antihistamine, intravenous fluids, beta2-agonist inhaler, epinephrine, position changes.
Understanding when to call for assistance and how to activate emergency response system(s).
Basic Life Support (BLS)
The provider of direct supervision must be immediately available to furnish assistance and direction throughout the performance of the procedure. This does not mean that the supervising provider or radiologist must be present in the room where and when the procedure is performed. However, there should be at least one person who can recognize adverse events related to contrast media administration in attendance (in the room or in an adjacent control room) to observe the patient during and immediately after the injection and summon medical assistance as needed. All local and state regulations regarding supervision of contrast media administration must be followed.
1 “Direct supervision” means the definition specified at 42 CFR 410.32(b)(3)(ii), that is, the physician must be immediately available to furnish assistance and direction throughout the performance of the procedure. It does not mean that the physician or must be present in the room when the procedure is performed.
2 “General supervision” means the definition specified at 42 CFR 410.32(b)(3)(i), that is, the procedure or service is furnished under the physician's overall direction and control, but the physician's presence is not required during the performance of the procedure.
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